Beading on cholangiography is characteristic of which autoimmune cholestatic disease?

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Multiple Choice

Beading on cholangiography is characteristic of which autoimmune cholestatic disease?

Beading on cholangiography reflects alternating strictures and dilatations of the biliary tree from inflammatory fibrotic changes, a classic feature of primary sclerosing cholangitis. This imaging pattern occurs in PSC because the disease affects both intrahepatic and often extrahepatic ducts, producing the characteristic beaded appearance on MRCP or ERCP. In contrast, primary biliary cholangitis targets small intrahepatic ducts and typically has a normal cholangiogram; its diagnosis is supported by antimitochondrial antibodies, which are highly specific for PBC, not PSC. Additionally, PSC can have overlap with autoimmune hepatitis in some patients, so the idea that PSC never overlaps AIH isn’t accurate.

Beading on cholangiography reflects alternating strictures and dilatations of the biliary tree from inflammatory fibrotic changes, a classic feature of primary sclerosing cholangitis. This imaging pattern occurs in PSC because the disease affects both intrahepatic and often extrahepatic ducts, producing the characteristic beaded appearance on MRCP or ERCP. In contrast, primary biliary cholangitis targets small intrahepatic ducts and typically has a normal cholangiogram; its diagnosis is supported by antimitochondrial antibodies, which are highly specific for PBC, not PSC. Additionally, PSC can have overlap with autoimmune hepatitis in some patients, so the idea that PSC never overlaps AIH isn’t accurate.

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